Backstory

How Aetna Failed My Child

So, I have all of these blog posts in the works, but I have to interrupt everything to let you know about something that I just learned about insurance and my college kid.

As you know, my daughter Vega was catastrophically ill this past spring with something that turned out to be vasovagal syncope, complicated by the rupturing of an ovarian cyst and some medication side effects. It took us almost three months to even figure out what she had, during which we saw doctor after doctor and had test after test.

During that time, our abysmal health insurance paid for very little of her treatment. In fact, in the middle of one appointment, with the cardiologist we liked best and who seemed to actually be invested in diagnosing and treating Vega, we were informed that the front desk had made a mistake and the office didn't accept our insurance after all. Appointment over. We were ushered out and referred to another cardiologist and had another wait to try to get into to see THAT doctor.

Those were some good times. Because you know what's SUPER fun? Having your child pass out in a doctor's office and not being able to actually receive medical care there. Seriously, she was in distress, we were both near tears, and I had to load her into a wheelchair, get her to the car and take her home. All those doctors right there in that office, and no help available because they didn't take our insurance.

Our insurance company is Aetna.

Vega's father and I are self-employed and we get our insurance on the open market. In Texas, because of its powerful insurance lobby, the options are awful and more awful. After PPOs (Preferred Provider Organization) were no longer supported or offered in the marketplace, what seemed like the next best option for us was an Aetna EPO (Exclusive Provider Organization.) This way, we could still see the physicians, like our Pediatrician, with whom we had long-standing relationships.

But here's the thing we didn't know: we are only able to see physicians in Texas. The plan has limited coverage for emergencies if you travel outside of Texas, and you can just forget about coverage for ongoing medical conditions or prescription refills if you are, say OFF AT COLLEGE AND NEEDING A LOCAL DOCTOR.

I had no idea.

In fact, we declined the health insurance through USC because we were already paying $1,500 per month ($18,000 per year) for our family to be covered by Aetna.

And because it never even occurred to us that our health insurance wouldn't actually pay for Vega to see a doctor in California. In fact, before she saw the doctor, she got a referrals from the student health center for doctors who took Aetna, and when she saw the physician, his office only charged her the co-pay because they thought she was covered.

Obviously, had I known otherwise, I would have made other arrangements. I never would have sent my medically fragile child off to school without decent health insurance.

Except I did.

I'm writing this at 3:00 AM after having jolted bolt upright with the realization that if something medically catastrophic had occurred, she might not have been able to find a doctor to treat her. In a way, we got so lucky --we found this out through a routine appointment in order to get her meds refilled. We got so lucky that her health improved so much that this was the only medical care she needed in her first semester at school. And we got lucky because our experience with Aetna is almost over and we will NOT be doing business with them again.

So, as always, learn from my experience. Nowhere, in any of the literature I read about sending a kid off to school (and you KNOW I read a lot!), was there the slightest suggestion that I should make sure she would be covered by my insurance in another state. We submitted our proof of insurance to the University with full confidence that she had adequate protection against something bad happening.

I am so tired of my healthcare, and the healthcare of the people I love, being held hostage by insurance companies. We need a better system. But failing that, we need a system that doesn't operate under shadow rules and fine print.

If you have a kid at college, are you SURE that he or she is covered by your insurance, even if he or she is going to school out of state?

Comments

Shaatizie said…

OMG! My heart breaks for you. This is a awful situation and so damn scary when it's one child at risk. Wish I could help you. Could you get into ObamaCare with a preexisting situation. I know to little to help you--all I can offer is my empathy. I know how anything that hurts our kids hurts us more than anything in the world.God be with you and all of us will hold you in our prayers.Stay strong.Take care of yourself as much as you can in these circumstances.

This was insurance through the ACA. Our options were just terrible. Hoping the plans carried by the various schools (mine and hers) will provide better coverage. Thank you for your amazing, constant support!

I would make a lot more money, and would have less stress, if I was in private practice. But I don't dare leave my job because of the health insurance. I am sick of insurance companies, pharmaceutical companies, and medical professionals who overcharge. All of this is in the name of greed. Love you, Barb!

I'm sorry you and your daughter went through this. AETNA is the worst. I had it years back, when a car hit me and bit off my foot. I spent almost as much time fighting them as going through the eight surgeries and physical therapy. They even lied to their own employee to get both of us off the phone. I can't write what I said to someone there to make them help: it could get me arrested now. I will say, once I got through I told them that either they needed to okay whatever my doctors decided or assign one person to my case as it was more complex than most. They did that - about a year after the last surgery. They cancelled me when my COBRA ran out, giving me a line about not offering individual policies in Louisiana. I went without for years, turned down for ridiculous policies, until the ACA came along. It's not perfect but I have something now. - Naomi

I am horrified at the sate of medical ethics in your already beleaguered country. A doctors first priority should be the patient, now how he/she is going to get paid. So, so wrong. I am so sorry you have had to deal with this kind of establishment in a time of distress. On the upside, Vega is ok.But I shudder to think of all those who cannot find the medical help they need . This is why we are here in NZ. My husband wanted to practise medicine in a public health so he would never be swayed by money.